Pimples and zits are common occurrences with puberty. But acne can be tough on teens, and the skin problem is not just for teenagers.
New recommendations on how to classify, diagnose and manage acne in adolescents have been released.
These recommendations, formed by the American Acne and Rosacea Society, are the first to detail evidence-based guidelines in managing the skin condition in kids.
"Be gentle when treating acne."
The recommendations, developed by a panel of pediatric dermatologists, pediatricians and acne specialists led by Lawrence Eichenfield, MD, from the Departments of Pediatrics and Medicine (Dermatology) at the University of California in San Diego, were designed to help doctors diagnose and manage acne in kids.
Based on a literary search, the panel identified 10 topic areas in diagnosing and treating acne in children. Two expert reviewers were assigned to each topic to develop and present recommendations for critique.
How is child acne classified?:
Under the recommendations, acne is divided into four categories:
- neonatal acne
- infantile acne
- mid-childhood acne
- preadolescent acne
Acne can also be categorized as comedonal (which includes whiteheads and blackheads), inflammatory (which includes small bumps and pustules, or pimples) or mixed.
The recommendations are based on the child's age and pubertal status, though the panel said that for girls, the start of their first period might be a better defining point between preadolescence and adolescence.
Children undergoing a physical examination would have the type and distribution of their acne lesions assessed. They would also be evaluated for height, weight, growth curve and possible blood abnormalities.
For infants and children younger than 7 years of age, doctors are advised to look for early sexual maturity and development or abnormal growths that could underlie some systemic abnormality.
The researchers said that most infantile acne is not linked with any underlying endocrine cause. Infant patients with additional signs of hormonal abnormality or children in mid-childhood should see a pediatric endocrinologist.
How can it be treated?:
Medicines for acne include:
- over-the-counter
- prescription
- combined topical medicines containing retinoids that deal with growth of the skin or antibiotics
Under the recommendations, products containing benzoyl peroxide (BP) can safely and effectively treat acne when used by themselves or in combination with other topical products for mild acne.
Topical medicines with BP, retinoids and antibiotics can be used for moderate acne, according to the recommendations.
Severe acne should be treated with oral antibiotics and topical medicines containing BP, which the researchers said can also be used for all acne types and severities.
While antibiotics work in some patients, others do not find them useful over topical medications, according to Glenn Kolansky, MD, a board certified dermatologist and dailyRx Contributing Expert.
"Many do not want to use oral medication," he said. "Accutane is good medication, however with the cost and all the potential side effects (real or imagined), its use has decreased significantly."
The recommendations suggest that doctors take into account hormonal therapy in pubertal females, oral isotretinoin and dermatology referral.
"BP has been shown to be the most widely studied of OTC products and has shown to be one of the most versatile, safe, inexpensive, and effective acne therapies," the panelists wrote in their report.
What else is recommended?:
According to the recommendations, doctors and patients should take several things into account when choosing an acne treatment:
- previous treatment history
- cost of the medications
- ease of medicine's use
Patients with acne are at risk of scarring, and adolescents with acne have higher rates of mental health problems, social impairment, depression and affective isolation.
Though facial hygiene is also important, the researchers said abrasive or vigorous scrubbing could worsen acne. Diet also plays a role.
"I would strongly advise patients to wash after working out in the gym or any athletic activity," Dr. Kolansky said. "I also advise patients when they are on long-term antibiotics to take probiotics or yogurt with live cultures."
The new recommendations were published online May 1 in the journal Pediatrics and are endorsed by the American Academy of Pediatrics. The authors were supported by the American Acne and Rosacea Society, which funded the study.
